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Hi everyone, I need your help.
I have an atrophic scar on my nose which severely affects my mental health.
1. I had an injury in May 2023 and two unsuccessful revisions with a local plastic surgeon in May 2023 and September 2023.
The first surgery was a total disaster, the stitches cut through the tissue because of inflammation and huge tension and the wound opened and healed with secondary intention which was absolutely ugly. The second surgery was better, but within a couple of months the scar widened and returned to its pre-operation state.
The scar now has a thin abnormal skin which looks flat while the other side of the nose tip is convex, and if pressed it looks concave (depressed). So, there's asymmetry here. It also has a staircase effect (original scar + secondary scars from stitches).
This scar literally drives me mad! I have absolutely no social life because of it. And what is worse, the stress from it activated my mental health issues which were dormant before.
2. What would you recommend?
Excision and suturing? Full-scale plastic surgery involving a local flap? Skin seeding technique? Excision and then fat grafting? Or fat grafting and then excision?
Is the correct strategy the same as for patients with skin cancer (MOHS), which involves skin flaps (bilobed / extended rotation flaps, etc.), full-thickness skin grafts etc.? Or just excision and proper suturing?
3. Also, I don't know if it's possible to use tension reducers on the nose.
I have seen many cases where mechanical devices are used to reduce tension, on the cheeks, on the forehead, in all areas, but not on the nose.
The nose has a complex 3D shape and the question arises, is it possible to use such devices to reduce tension on the nose? I'm afraid that even if it is possible, they won't be very effective, due to the complex convex and concave shape of the nose.
Or is there no problem here?
4. I have been trying to research this topic, and from what I understand, the nose area is an undesirable area for all sorts of surgeries, due to the high tension and oily skin there.
But I would still like to remove the abnormal tissue because most likely, if it is not removed, there will be low pigmentation there, it will never tan, and it will stand out, even if the shape is restored with fillers.
5. I came to the conclusion that I should do another one excision + suture surgery first and then, after 18 or 24 months, I will use fillers if the surface is still not convex enough.
Is this a right strategy?
6. Also, I have smaller scars on my nose, on the other side of my nose, can you assess the possibility of treating them? They are in the last 2 pictures.
7. How can I improve the overall look of the skin on my nose? It looks badly. Tretinoin?
Any advice will be highly appreciated!
Thank you in advance,
Sincerely, SimonSays1337
This hits hard, as I have literally almost the same exact scar (same placement and size). And the same thing about it affecting my mental health. Like, heavily.
I personally have tried microneedling, but did not see any improvement. Maybe it even worsened the texture of the surrounding skin.
But the main reason I am writing is the suggestion for you to try Botox. Not sure if you have the same issue, but, because of the scar tethering to the fibromuscular layer, whenever there was a movement in my dilator naris anterior (DNA) muscle, the scar resulted in a massive dent. After many months of research, I took a leap of faith and did Botox to the DNA (3 units on each side). IT WORKED LIKE A MIRACLE. Literally, in 5 hours the muscle froze and that dent was gone. Obviously, the scar remains, but at least it does not distort my nose anymore. Unfortunately, have to do Botox every 3 months now. But it is still a massive improvement for me, also in terms of my mental health.
Good luck.
Hope you find a better treatment/solution. Delicate area, you definitely need experts on nasal surgery to assess that one spot. You list a lot of things but you probably just need to get more expert opinions because honestly the nasal area is very sensitive a lot of things can go wrong. Everything you type to me doesn't sound super conclusive. No tretinoin won't work imo. I don't believe so.
I'm afraid of making it worse frankly given there's tissue loss there. The pigment producing cells are damaged in that spot, same with my cheek. That's not easily treated so it's difficult. The texture is also not easily cured. A lot of it is hereditary. I have terribly texture you wouldn't believe in my cheeks. Some of that you just have to accept. No plastic surgeon really fixes texture that well imo without most cases risky/worsening.
Don't rush into anything and try to get more conclusive advice. I know it stinks. I'm on my 7th doctor's consult for cheeks. The nose is a tough one. I'd say go slowly if you're not sure. But as for tretinoin I tried for 6+ months I don't think it helped in fact it may have just irritated my texture more lol.